Interchangeable surgical instrument

ABSTRACT

A system and associated method for delivering to an internal body site a selected one of a plurality of instruments. An instrument storage chamber is providing having passages for separately accommodating a plurality of instruments. An outlet guide tube couples from the instrument storage chamber and receives a selected one of these instruments for delivery to an internal operative site. An indexing mechanism is provided associated with the chamber for causing relative displacement between the instruments and the outlet guide tube. An instrument driver displaces the registered instrument from the chamber into the outlet guide tube for delivery to the internal operative site.

RELATED APPLICATIONS

[0001] This application is a continuation-in-part of and claims thebenefit of priority from U.S. application Ser. No. 10/034,871, filedDec. 21, 2001; U.S. application Ser. No. 09/827,503, filed Apr. 6, 2001,which is a continuation of U.S. application Ser. No. 09/746,853, filedDec. 21, 2000, which is a divisional of U.S. application Ser. No.09/375,666, now U.S. Pat. No. 6,197,017, filed Aug. 17, 1999, which is acontinuation of U.S. application Ser. No. 09/028,550 filed Feb. 24,1998, now abandoned. This application is also a continuation-in-part ofand claims the benefit of priority from U.S. application Ser. No.09/783,637, filed Feb. 14, 2001, which is a continuation ofPCT/US00/12553 filed May 9, 2000, which claims the benefit of priorityof U.S. provisional patent application Ser. No. 60/133,407, filed May10, 1999, now abandoned. This application is also a continuation-in-partof and claims the benefit of priority from PCT/US01/11376 filed Apr. 6,2001 which claims priority to U.S. application Ser. Nos. 09/746,853filed Dec. 21, 2000 and 09/827,503 filed Apr. 6, 2001. This applicationis also a continuation-in-part of and claims the benefit of priorityfrom U.S. application Ser. Nos. 09/746,853 filed Dec. 21, 2000 and09/827,503 filed Apr. 6, 2001. This application is also acontinuation-in-part of and claims the benefit of priority from U.S.application Ser. No. 09/827,643 filed Apr. 6, 2001 which claims priorityto, inter alia, U.S. provisional application Ser. No. 60/257,869 filedDec. 21, 2000 and U.S. provisional application Ser. No. 60/195,264 filedApr. 7, 2000 and is also a continuation-in-part of PCT/US00/12553 filedMay 9, 2000 from which U.S. application Ser. No. 09/783,637 filed Feb.14, 2001 claims priority.

[0002] This application also claims the benefit of priority under 35U.S.C. §§119 and 120 to U.S. Provisional Application Serial. No.60/332,287 filed Nov. 21, 2001, U.S. Provisional Application Serial. No.60/344,124, filed Dec. 21, 2001 U.S. Provisional Application Serial No.60/293,346 filed May 24, 2001, U.S. Provisional Application Serial No.60/279,087, filed Mar. 27, 2001, U.S. Provisional Application Serial No.60/313,496 filed Aug. 21, 2001, U.S. Provisional Application Serial No.60/313,497 filed Aug. 21, 2001, U.S. Provisional Application Serial No.60/313,495 filed Aug. 21, 2001, U.S. Provisional Application Serial No.60/269,203 filed Feb. 15, 2001, U.S. Provisional Application Serial No.60/269,200 filed Feb. 15, 2001, U.S. Provisional Application Serial No.60/276,151 filed Mar. 15, 2001, U.S. Provisional Application Serial No.60/276,217 filed Mar. 15, 2001, U.S. Provisional Application Serial No.60/276,086 filed Mar. 15, 2001, U.S. Provisional Application Serial No.60/276,152 filed Mar. 15, 2001, U.S. Provisional Application Serial No.60/257,816 filed Dec. 21, 2000, U.S. Provisional Application Serial No.60/257,868 filed Dec. 21, 2000, U.S. Provisional Application Serial No.60/257,867 filed Dec. 21, 2000, U.S. Provisional Application Serial No.60/257,869 filed Dec. 21, 2000.

[0003] This application further is a continuation-in-part of and claimsthe benefit of priority from the following U.S. patent applications allfiled on Nov. 16, 2001 and identified as U.S. Ser. No. 10/014,143; U.S.Ser. No. 10/012,845; U.S. Ser. No. 10/008,964; U.S. Ser. No. 10/013,046;U.S. Ser. No. 10/011,450; U.S. Ser. No. 10/008,457; U.S. Ser. No.10/008,871; U.S. Ser. No. 10/023,024; U.S. Ser. No. 10/011,371; U.S.Ser. No. 10/011,449; U.S. Ser. No. 10/010,150; U.S. Ser. No. 10/022,038;and U.S. Ser. No. 10/012,586.

[0004] The disclosures of all of the foregoing applications and U.S.Pat. No. 6,197,017 are all incorporated herein by reference in theirentirety.

BACKGROUND OF THE INVENTION

[0005] The present invention relates in general to medicalinstrumentation. More particularly, the present invention relates to asurgical instrumentation system that enables the interchange of any oneof a number of different surgical instruments at an operative site.

[0006] In open surgery a surgeon uses a variety of different surgicalimplements with the total number that are used being a function of theparticular operation being performed. For the most part theseinstruments or implements are hand held devices directly held andmanipulated by the surgeon through the open incision. Typical surgicalinstruments include forceps, needle drivers, scissors, scalpels, etc. Anumber of different instruments or implements may be used during anoperation depending upon the complexity of the medical procedure beingperformed, and even a greater number of instrument exchanges occur.Thus, a great deal of time may be spent during the surgery simply inexchanging between different types of instruments.

[0007] In minimally invasive surgery (MIS) there is likewise arequirement, depending upon the particular surgical procedure, toexchange instruments or implements during a medical procedure. Theprimary difference in minimally invasive surgery is that the incision orincisions are relatively small, typically 5 mm to 10 mm in diameter, incomparison to open surgery. Also, in current MIS instrumentation, suchinstruments as forceps, scissors, etc., are inserted into the body atthe end of long slender push rods actuated by the surgeon from outsidethe patient. Due to the size and increased complexity of theseinstruments it may be even more difficult to carry out an exchange dueto the need to extract and re-insert through a relatively smallincision.

[0008] Both open and MIS procedures involve control of the instrumentdirectly by the human hand. In the case of open surgery, of course, thesurgeon directly holds and manipulates the instrument, while in MIS theoperable tool (scalpel, scissors, etc.) is controlled by hand, butthrough some type of mechanical transmission that intercouples fromoutside the patient to an internal operative site.

[0009] In more recent years computer control of instrumentation systemshas come into being, typically referred to as robotic surgical systems,in which a surgeon controls an instrument carrying an end effector froma remote site, and through an electronic controller or the like. Theserobotic systems do provide an improvement in the dexterity with whichmedical procedures can be performed. However, even in these moreadvanced systems there is still a need to manually exchange instrumentsduring a procedure.

[0010] Accordingly, it is an objective of the present invention toprovide a system and associated method for the ready exchange orinterchange between a plurality of different instruments at an operativesite, whether it be in connection with open, MIS, robotic, or othertypes of surgical systems, apparatus, or procedures.

BRIEF SUMMARY OF THE INVENTION

[0011] The present invention is directed to a system, apparatus, ormethod for enabling the exchange or interchange between one of severaldifferent instruments or implements, so that these different instrumentsor implements can be readily delivered to an operative or target sitewithin a patient for performing a medical or surgical procedure. Thepresent invention carries out this exchange or interchange without theusual manual withdrawal and insertion that is typical of prior artsystems, and can be said to perform this interchange or exchangeessentially automatically, with little or no manual intervention. Theprinciples of the present invention are intended to apply to anyinstruments or implements, whether for open, MIS, or robotic surgeryuses. The tool or end effector of the instrument may be of any typeincluding, but not limited to, articulated and non-articulated types.

[0012] In accordance with one aspect of the present invention there isprovided an interchangeable instrument apparatus that includes aplurality of separate instrument members each capable of assisting in adifferent phase of a medical procedure to be performed at an operativesite within the anatomy. An instrument storage chamber releasablyreceives the plurality of instrument members. The instrument members areaccommodated in separate storage locations within the instrument storagechamber. An instrument driver is constructed and arranged forcooperative positioning relative to the instrument storage chamber, forselective alignment with one of the instrument members at a time, andfor displacing or driving the aligned instrument member from theinstrument storage chamber toward the operative site. At least one ofthe instrument driver and instrument storage chamber are positionallycontrollable so as to provide relative displacement therebetween so asto selectively align the instrument driver with another of theinstrument members.

[0013] In accordance with another aspect of the present invention thereis provided a surgical instrument apparatus that comprises an instrumentmember that includes two sections including a work section that supportsat its distal end a tool used in performing a medical procedure at anoperative site within the anatomy, and a driver section that isreleasably engageable with the work section. The apparatus also includesa guide member for receiving the work section and the driver section,and for directing, upon engagement of said driver section with said worksection, the delivery of the tool to the operative site. The driversection, in an inoperative position thereof, is disengaged from the worksection, and in an operative position thereof, is engageable with thework section to direct the work section, via the guide member, to theoperative site, and further is engageable with the work section toenable operative coupling to the tool for actuation of the tool from aremote drive unit.

[0014] In accordance with still another aspect of the present inventionthere is provided a method of delivering, to an internal operative site,a selected one of a plurality of instruments. The method comprising thesteps of; storing a plurality of separate instruments in a storagechamber with each instrument capable of assisting in a different phaseof a medical procedure to be performed at the operative site, andproviding an instrument driver constructed and arranged for;

[0015] cooperative positioning relative to the instrument storagechamber,

[0016] selective alignment with one of the instruments at a time, and

[0017] displacing the aligned instrument from the instrument storagechamber.

[0018] At least one of the instrument driver and instrument storagechamber are positionally controlled so as to provide relativedisplacement therebetween, and so as to selectively align the instrumentdriver with another one of the instrument members

[0019] In accordance with another aspect of the present invention thereis provided a storage chamber that supports a plurality of separatelyarranged instruments, and further includes inlet and outlet ports. Theoutlet port is arranged in alignment with the target or operative sitewhere the instrument is to be delivered. The instrument carries at itsdistal end a work implement(tool). An instrument driver is in alignmentwith the inlet port, and is adapted to engage a registered instrumentdisposed in the storage chamber, so as to deliver the selectedinstrument, via the outlet port, to the target or operative site. Theinstrument driver, in addition to engagement with the instrument, alsooperatively couples with and enables operation of the work implement ofthe instrument. The storage chamber is selectively operable, uponcommand, to permit different instruments to align between the inlet andoutlet ports.

[0020] In accordance with another aspect of the present invention thereis provided a surgical instrument apparatus that includes an instrumentmember having a work section that supports at its distal end a tool usedin performing a medical procedure at an operative site within theanatomy, and a driver section that is releasably engageable with thework section. A guide member receives the work section and the drivesection, and is for directing, upon engagement of the driver sectionwith the work section, the delivery of the tool to the operative site.The driver section, in an inoperative position thereof, is disengagedfrom the work section, and in an operative position thereof, isengageable with the work section to direct the work section, via theguide member, to the operative site, and is further engageable with thework section to enable operative coupling to the tool for actuation ofthe tool from a remote drive unit. The apparatus also preferablyincludes an interface or coupling section between the work and driversections for selectively and releasably intercoupling therebetween.

[0021] The present invention is also directed to an interchangeablemedical instrument system that includes an instrument storage retainerthat supports a plurality of separately arranged instruments, andfurther includes inlet and outlet ports, the outlet port arranged inalignment with the a target or operative site where the instrument is tobe delivered for performing a medical procedure. A work implement issupported at the distal end of each instrument. An instrumenttransporter is in alignment with the inlet port, and adapted to engage aregistered instrument disposed in the storage retainer, so as to deliverthe selected instrument, via the outlet port to the target or operativesite. The instrument transporter, in addition to engagement with theinstrument, also operatively couples with and enables operation of thework implement of the instrument The retainer is selectively operable,upon command, to permit different instruments to align between the inletand outlet ports.

[0022] The present invention is also directed to an interchangeableinstrument system that includes an instrument retainer having multiplestorage location for receiving a plurality of instruments disposedseparately in the respective storage locations, and an instrument driverconstructed and arranged for cooperative positioning relative to theinstrument retainer, for selective alignment with one of the instrumentsat a time, and for displacing the aligned instrument from the instrumentretainer and toward the operative site. An indexing mechanism controlsthe position of the instrument retainer so as to selectively aligndifferent instruments with the instrument driver. An actuation member isdisposed at a user interface for controlling the indexing mechanism.

[0023] Another aspect of the present invention is an interchangeableinstrument system that includes a plurality of medical instruments, aninstrument retainer for releasably holding the plurality of instruments,and an instrument transporter associated with the instrument retainer,for selective alignment with one of the instruments at a time, and fordisplacing the aligned instrument from the instrument retainer toward anoperative site in a subject. Either the instrument retainer orinstrument transporter may be positionally controllable so as to providerelative displacement therebetween so as to selectively align theinstrument transporter with another instrument. The instrument retainermay comprise a rotating chamber having a plurality of passages therein.Alternatively, the instrument retainer may comprise a linear chamber forreceiving the instruments. The transporter may be positioned in parallelto the linear chamber, and a selected instrument is moved transverselyout of the chamber for alignment with the instrument transporter.

[0024] In another aspect of the invention there is provided a remotelycontrollable medical apparatus comprising: a remote user interfacemanually manipulable by a user for sending operation command signals toa signal processor, the signal processor processing the command signalsand sending processed signals to a drive mechanism; an instrumentexchange mechanism mechanically intercoupled to the drive mechanism; theinstrument exchange mechanism comprising a shaft and an instrumentdelivery mechanism containing two or more selected instruments; theshaft having a lumen which readily receives the selected instruments forinsertion and withdrawal from the lumen; the instrument deliverymechanism being drivably movable to align a selected instrument with thelumen of the shaft for insertion and withdrawal to and from the lumen,the instrument delivery mechanism being remotely drivable via the userinterface to insert and withdraw selected instruments.

[0025] In another aspect of the invention there is provided a remotelycontrollable medical apparatus comprising: a remote user interfacemanually manipulable by a user for sending operation command signals toa signal processor, the signal processor processing the command signalsand sending processed signals to a drive mechanism; an instrumentexchange mechanism mechanically intercoupled to the drive mechanism; theinstrument exchange mechanism comprising a shaft and an instrumentdelivery mechanism containing two or more selected instruments; theshaft having a lumen which readily receives the selected instruments forinsertion and withdrawal from the instrument delivery mechanism; aninstrument drive mechanism mechanically intercoupled to the drivemechanism and readily mechanically couplable to and decouplable from aninstrument; the instrument drive mechanism being remotely drivable viathe user interface to operably couple to and drive an instrument.

BRIEF DESCRIPTION OF THE DRAWINGS

[0026] These and other features of the present invention are describedin greater detail in the following detailed description, taken inconjunction with the accompanying drawings, in which:

[0027]FIG. 1 is a perspective view of one embodiment of a roboticsurgical system in which the interchangeable instrument principles ofthe present invention are applied;

[0028]FIG. 2 is a perspective view showing a portion of the system ofFIG. 1, particularly the storage chamber and the driving mechanism;

[0029]FIG. 3 is a cross-sectional view illustrating the storage chamber,the driver and the associated positioning of components, and as takenalong line 3-3 of FIG. 2;

[0030]FIG. 4 is a perspective view showing some further detail of theinstrument in this first embodiment;

[0031]FIG. 5 is a partial cross-sectional view showing further detailsof the driver and instrument in this first embodiment;

[0032]FIG. 6 is a further cross-sectional view similar to thatillustrated in FIG. 5 but showing the driver and instrument in aninterlocked position;

[0033]FIG. 7 is a schematic cross-sectional perspective view thatillustrates details of the instrument of the present invention;

[0034]FIGS. 8A and 8B are perspective views of the tool component of thesurgical instrument illustrating the cabling scheme;

[0035]FIG. 9 is a perspective view of an alternate embodiment of thepresent invention, providing linear registration rather than rotationalregistration;

[0036]FIG. 10 is a perspective view of another embodiment of a roboticsurgical system in which the interchangeable instrument principles ofthe present invention are applied;

[0037]FIG. 11 is a perspective view at the slave station of the systemof FIG. 10 illustrating the interchangeable instrument concepts;

[0038]FIG. 12 is a cross-sectional view through the storage chamber andas taken along line 12-12 of FIG. 11;

[0039]FIG. 13 is a longitudinal cross-sectional view, as taken alongline 13-13 of FIG. 11;

[0040]FIG. 14 is a perspective schematic view of the indexing mechanismused in the embodiment illustrated in FIGS. 10-13;

[0041]FIG. 15 is a block diagram illustrating the steps taken to provideindexing for instrument interchange; and

[0042]FIG. 16 is a schematic diagram of another alternate embodiment ofthe invention using a serial storage concept.

DETAILED DESCRIPTION

[0043] In this detailed description there is described an apparatus forenabling the interchange, at an operative site, between different typesof surgical instruments and in an automated fashion. In this way asubstitution of one instrument for another can be readily accomplished,without manually withdrawing one instrument followed by manual insertionof another instrument. Further, with this apparatus, and the associateduse of a guide tube, or the like, for receiving and guiding theinstrument, the interchange can be carried out quickly and safely, thusenabling medical procedures to be performed in a far shorter period oftime. The guide tube preferably extends to the operative site OS (seeFIG. 7) so that the instrument can transition safely thereto. Also, theguide tube preferably remains at the operative site even as theinstruments are exchanged in the guide tube, so as to avoid any tissueor organ damage during an instrument exchange. The operative site may bedefined as the general area in close proximity to where movement of thetool occurs in performing a surgical procedure, usually in the viewingarea of the endoscope and away from the incision.

[0044] In this description the instrument interchange principles areillustrated in association with two separate surgical systems, both ofwhich are robotic systems, sometimes also referred to as teleroboticsystems. However, the principles of this invention also apply to othersurgical instrumentation, such as used in minimally invasive surgery(MIS), where a number of instrument exchanges are typical in performinga medical or surgical procedure.

[0045] It is assumed, by way of example, that the systems disclosedherein are for use in laparoscopic surgery. Thus, one system isdisclosed in FIGS. 1 through 8A and 8B, while a second system isdisclosed in FIGS. 10-14. A variation of the first system is illustratedin FIG. 9. It is noted that in FIG. 9, the instrument-to-driverregistration is accomplished with a linear arrangement, while in theother versions described herein a rotating arrangement is employed, allto be described in further detail later. Also, in the embodimentsdescribed herein the driver has only linear translation while theinstrument storage chamber rotates (FIGS. 1 and 10) or slides (FIG. 9).In an alternate embodiment the driver may rotate or otherwise move todifferent registration positions, as the instrument storage chamberremains stationary, as long as there is relative motion between theinstrument driver and instrument storage chamber.

[0046] Before reference is made to the detailed embodiments describedherein, consideration is given to co-pending applications that arehereby incorporated by reference herein in their entirety, and thatdescribe in further detail aspects of the several components that makeup the overall robotic surgery system. In connection with descriptionsset forth herein reference is made to the applications set forth in therelated application part of this application as well as to pending U.S.application Ser. No. 09/783,637 filed Feb. 14, 2001; U.S. applicationSer. No. 10/014,143 filed Nov. 11, 2001; as well as issued U.S. Pat. No.6,197,017.

[0047] The first embodiment of the invention is illustrated in FIGS.1-8. FIG. 1 shows a surgical instrument system 10 that performs surgicalprocedures. The system may be used to perform minimally invasiveprocedures. The system may also be used to perform open or endoscopicsurgical procedures. The system 10 includes a surgeon interface 11,computation system 12, and drive unit 13. The system controls theinstrument so as to position the end effector (tool) 18 of theinstrument 20 at the very distal end of and extending through the outletguide tube 24. During use, a surgeon may manipulate the handles 30 ofthe surgeon interface 11, to effect desired motion of the end effector18 within the patient, at the operative site which is schematicallyillustrated in FIG. 7. The movement of a handle 30 is interpreted by thecomputation system 12 to control the movement of the end effector (tool)18.

[0048] The system may also include an endoscope with a camera toremotely view the operative site. The camera may be mounted on thedistal end of the instrument, or may be positioned away from the site toprovide additional perspective on the surgical operation. In certainsituations, it may be desirable to provide the endoscope through anopening other than the one used by the instrument.

[0049] The entire assembly illustrated in FIG. 1 is shown supported overthe surgical table 27, and in a position so that the guide tube 24 canbe inserted through an incision in the patient and directed to theoperative site of the patient. The incision is represented in FIG. 1 bythe dashed line L. The surgical instrument system 10 of the presentinvention is preferably mounted on rigid post 19 which may be movablyaffixed to the surgical table 27, at bracket 28.

[0050] The surgical system 10 includes two mechanical cable-in-conduitbundles 21 and 22. These cable bundles 21 and 22 terminate at one end atthe two connection modules(couplers) 23A and 23B, which removably attachto the drive unit 13. The drive unit 13 is preferably located outsidethe sterile field, although it may be draped with a sterile barrier sothat it may be operated within the sterile field. The other end of thebundles terminate at the surgical system 10. These terminations areshown in further detail in the description of the second embodiment thatis described later. Basically cables in the bundle 21 may control; theindexing for controlled rotation of the instrument storage chamber 40;rotation of the guide tube 24; as well as motion of the carriage 54 forcontrol of the linear translation of the driver 50. On the other handthe bundle 22 may control, for example, rotation of the instrumentwithin the guide tube 24, as well as actuation of the tool 18. Theinstrument storage chamber is also referred to herein as an instrumentretainer.

[0051]FIG. 1 also shows the instrument storage chamber 40 that isillustrated as supported over the base piece 51, which, in turn, issupported from the rigid post 19. The cable bundle 21 couples to thebase piece 51 and controls motion of the instrument storage chamber 40,as well as the driver 50. The guide tube 24 is supported at the outletport side of the instrument storage chamber 40, and is controlled forrotation relative to the instrument storage chamber 40. Rotation of theguide tube 24 provides a corresponding rotation of the instrument andtool. The instrument storage chamber 40 has at its inlet side a port forreceiving the driver 50, and for permitting engagement of the driverwith the one of the instruments in the instrument storage chamber 40that is in registration with the driver 50. The driver 50 is supportedfrom the carriage 54 which transitions on rails 55, and is controlledfrom cable bundle 22. The driver may also be referred to herein as aninstrument transporter.

[0052] In accordance with the setup of the system of FIG. 1, the guidetube 24 of the surgical instrument system 10 is inserted into thepatient usually through an incision. Usually, a cannula is positioned inthe incision, is maintained in position and receives the guide tube 24.This incision is illustrated in FIG. 1 by the dashed line L. The systemis then mounted to the rigid post 19. The cable bundles 21 and 22 arethen coupled to the drive unit 13. The connection modules or couplers23A and 23B at the end of respective cable bundles 21 and 22 are thenengaged into the drive unit 13. The system is then ready for use andcontrol from the master station side at surgeon interface 11. Forfurther details of the entire slave side of the system, including thedrive unit, detachability at the drive unit, the cabling and cablecouplers, refer to U.S. Ser. Nos. 09/783,637; and 10/014,143, previouslymentioned.

[0053] Now, reference is made, not only to FIG. 1 but also to FIGS. 2through 6 that illustrate further details depicting the interchangeableinstrument concepts of the present invention. FIG. 7 illustratesschematically a cabling scheme that may be used in the instrument. FIG.9 illustrates an alterative to the revolving chamber construction, inthe form of a linearly translatable housing or chamber arrangement.

[0054] The revolving instrument storage chamber 40 includes a base 42,opposite end walls 43 and a cylindrical chamber or magazine 44. In theembodiment illustrated herein, chamber 44 has six elongated passages 46each for receiving an instrument. The chamber 44 is supported by acentrally disposed support rod 47, such as illustrated in FIG. 5. Thesupport rod 47 may be supported in bearings (not shown) at the oppositeend walls 43. The instrument storage chamber 40 has its rotationcontrolled at base piece 51 (see FIG. 1) so that when an operator atinterface 11 wants to change instruments, a command can be sent from themaster to the slave side to rotate the magazine 44 so that a differentinstrument is in alignment with the driver 50. Of course, this exchangeonly occurs when the driver has been withdrawn to its rest (disengaged)position. Specific sequences of the interchange action are describedlater. The command that is sent may be initiated by any one of severalmeans, some of which are described in some detail later.

[0055]FIGS. 2 and 3 also illustrate the outlet guide tube 24. The tube24 is secured to one of the end walls 43 and is essentially fixed inaxial position relative to that end wall 43 of the rotating instrumentstorage chamber 40, but is capable of rotation on its own axis, andrelative to the chamber 40. Details of this rotational support aredescribed further in connection with the second embodiment described inFIGS. 10-14. The end walls 43 supporting the magazine 44 are fixed tothe base 42, which is supported over the base piece 51 which, in turn,is fixed to the rigid post 19. Thus, in this particular embodiment theinstrument storage chamber 40 rotates but does not have any significantlinear movement toward or away from the operative site. Thus, in thisfirst embodiment the instrument control has a somewhat limited number ofdegrees-of-freedom. The degrees-of-freedom can be increased by providingthe guide tube with a curved distal end, like that illustrated in thesecond embodiment of the invention in FIGS. 10-14.

[0056]FIGS. 1 through 6 also illustrates the instrument driver 50. Theinstrument driver 50 is adapted to enter an end inlet port 49 in thewall 43 of the rotating chamber 40. In this regard, refer to FIG. 3 forthe inlet port 49. Also, as discussed previously in connection with FIG.1, in the base piece 51 there is an indexing mechanism that controls therotation of the rotating storage chamber 44 so that different ones ofthe passages 46 are adapted to be aligned with the input driver port 49.This registration control may be carried out using a detent mechanism sothat the proper instrument is aligned and selected from the chamber bythe instrument driver 50. Refer to FIG. 2 and the cable bundle 21 thatinterconnects with the chamber 44 for selective and registered rotationthereof. Also, refer to FIG. 14 for an example of an indexing mechanism.

[0057] In a similar manner, at the opposite end wall 43 of the chamber40, there is provided an outlet port 48, such as illustrated in FIG. 3,and that aligns with the outlet guide tube 24. Also, in FIGS. 2 and 3there is illustrated the carriage 54 that carries the instrument driver50 and that transitions along the support rails 55 to enable the driverto selectively engage with and drive the instrument forward through theguide tube 24 and toward the operative site.

[0058]FIG. 3 illustrates a cross-sectional view of one embodiment of theinterchangeable instrument apparatus of the present invention. Aninstrument 20 with its end effector (tool) 18 is illustrated disposed inone of the elongated chambers 46 of the rotating chamber 44. Inpractice, each of the other passages 46 can contain other types ofinstruments, with a variety of different tool or end effectors. For thesake of clarity, only one of the instruments is illustrated in FIG. 3,it being understood that up to six other instruments of different typesmay be disposed in other ones of the elongated passages 46. Also, themagazine 44 may be constructed with fewer or more instrument-receivingpassages. FIG. 3 also illustrates the driver 50 in a position where theend 56 thereof is positioned just entering the inlet port 49 with theend 56 about to engage the end 25 of the instrument 20. The position ofthe instrument driver 50 is considered as a “rest position” when the end57 is disposed in wall 43, but has not yet entered the magazine 44 sothat the magazine 44 is free to rotate. To interlock and align thedriver and the instrument, there is provided a post 58 (see FIG. 5) onthe driver 50 and an accommodating recess 26 (see FIG. 5) in theinstrument end 25.

[0059] As mentioned previously, there are mechanical cables extending inbundles 21 and 22 illustrated in FIG. 1. The cables in bundle 22, inparticular, couple by way of pulleys and then extend the length of thedriver 50 to the instrument 20. The cabling and control pulleyarrangements are disclosed in further detail in the second embodiment asshown in FIGS. 10-14. This cabling is for operating the end effector 18illustrated in FIG. 1. To provide continuity of this mechanical controlcabling, both the instrument driver as well as the instrument carryinterconnecting cable connections. These are illustrated clearly inFIGS. 4 through 6. Also refer to the schematic perspective view of FIG.7 showing the manner in which the cables couple about pulleys 29 andextend through the driver to intercouple with cabling of the instrument20. These cable connections between the driver and instrument may alsobe considered as defining a coupling section or coupling interface 59where the driver and instrument are releasably engageable. One may alsoconsider the driver and instrument, such as illustrated in FIGS. 1-6, ascollectively being an instrument member including a work section(instrument 20 and tool 18), and a driver section (driver 50).

[0060] The instrument driver 50 has passages 61 (see FIG. 4) forreceiving a cable 62 (see FIGS. 4, 5 and 6). As illustrated in FIGS. 4,5 and 6 the end of cable 62 terminates in a hook 64. The hook 64 isadapted to engage with a similar-configuration hook 66 at the end ofcable 68 as illustrated in FIG. 6. FIG. 4 illustrates a series of slotsor passages 61, which in the illustrated embodiment comprise six suchslots 61. Each of these slots receives a cable 62 with its end hook 64.

[0061] Referring further to FIG. 4, this illustrates the end 25 of theinstrument 20. Also illustrated are the elongated slots 61 in thedriver(transporter) 50. FIG. 4 illustrates the cables 68 and theirassociated hooks 66 associated with the instrument 20. Also shown is thecable 62 with its hook 64 disposed in slot 61.

[0062]FIG. 5 illustrates the end 56 of the instrument driver 50 as thedriver 50 is transitioning through the port 49 for engagement with theinstrument 20. The driver 50 has not yet engaged the instrument 20, buthas just left its rest position. The “rest” (disengaged) position forthe instrument driver 50 is one in which the end 56 of the driver 50 isdisposed in the end wall 43 and out of the passage 46 so that thechamber 44 is free to rotate. In the position of FIG. 5, the hook 66associated with the instrument 20 is preferably biased to a somewhatoutward deflected position. In this regard, it is noted that the passage46 has an enlarged section 46A that permits the hook 66 to deflectoutwardly, as illustrated. The hooks are essentially spring biasedoutwardly so as to contact the inner wall surface of enlarged section46A. This enables the driver to pass by the hooks 66 for engagement withthe instrument 20.

[0063] As the driver 50 proceeds from the position illustrated in FIG.5, toward the position illustrated in FIG. 6, the hook 64 passes underthe hook 66 and as the driver is driven further to the left, as viewedin FIG. 3, the hooks 64 and 66 become interlocked in the positionillustrated in FIG. 6 and there is thus cable continuity from cable 62to cable 68. As is discussed in further detail hereinafter, theoperation of these cables provide operation of certain actions of theend effector 18. As the driver end 56 engages the instrument end 25, thepost 58 engages with the recess 26 so as to properly align the driverand instrument. At the initial point of contact the hooks 66 are stillout of engagement with the hooks 64. However, as the driver movesfurther to the left the instrument starts to transition out of thestorage chamber passage 46, and the hooks 66 transition into the smallerdiameter section of the passage 46, causing them to deflect intoengagement with the hooks 64, such as illustrated in FIG. 6. Thecoupling interface 59 formed essentially between the hooks 64 and 66 ismaintained as the instrument transitions out of the instrument storagechamber 40. Refer to FIG. 7.

[0064] The driver 50 is of a sufficient length so that the selectedinstrument 20 is driven out of the chamber 44 and into the outlet guidetube 24. The instrument is then transitioned through the guide tube 24to the position illustrated in FIG. 1 where the end effector or tool 18of the instrument extends from the distal end of the guide tube 24 at aposition inside the body cavity (operative site). All the while that theinstrument is being transitioned to the end of the guide tube 24, theinterconnecting cables are maintained in an interlocked position such asillustrated by the engaged hooks 64 and 66 in FIG. 6.

[0065] When it is desired to change to a different instrument, thedriver 50 is withdrawn or in other words is moved in a direction to theright in FIG. 3. This carries the instrument with the instrument driverto the right and when the instrument reaches a position approximately asillustrated in FIG. 5, because of the increased diameter of the section46A illustrated in FIG. 5, the hooks 66 are biased outwardly anddisengage from the hooks 64. This essentially disengages the driver fromthe instrument and the driver is then in a position to be withdrawnthrough the port 49, no longer engaging with the instrument. This alsoleaves the instrument 20 in place in the instrument storage chamber 44in readiness for a subsequent usage.

[0066] With the driver disengaged from the instrument, the instrumentstorage chamber can then be rotated to align a different instrument withthe driver. The cabling in bundle 21, via base piece 51, controls theposition of chamber 40 so as to select a different instrument byrotating the chamber 44 so that a different instrument registers withthe driver 50. For an example of a registration mechanism refer to FIG.14. A different instrument would also carry cabling similar to thatillustrated in FIG. 5. Once the new instrument is in-line with theinstrument driver 50 then the driver 50 may be engaged once again topass through the port 49 engaging the new instrument and thustransitioning the new instrument out the outlet guide tube 24 to aposition where the tool of the instrument is at the operative site inreadiness for use and control from the master station surgeon interface.

[0067] A wide variety of different instruments may be supported in theinstrument storage chamber 40. Tool 18 may include a variety ofarticulated tools, such as jaws, scissors, graspers, needle holders,micro dissectors, staple appliers, tackers, suction irrigation tools,clip appliers, that have end effectors driven by wire links, eccentriccams, push-rods or other mechanisms. In addition, tool 18 may comprise anon-articulated instrument, such as cutting blades, probes, irrigators,catheters or suction orifices. Alternatively, tool 18 may comprise anelectrosurgical probe for ablating, resecting, cutting or coagulatingtissue.

[0068] To provide proper alignment of the instrument 20 in the chamber40 and with the driver 50 there are preferably provided interlockingsurfaces such as a tongue and groove (not shown) between the walls ofthe chamber passage and the outer surface off the instrument and/ordriver. Interlocking or guiding surfaces may also be provided within theguide tube 24. Thus, as the different instruments are moved in and outof the rotating chamber they will always be properly aligned with thedriver so that the proper cabling is provided to control the instrument.

[0069] Reference is now made to FIG. 7 for a schematic illustration ofthe cabling as it extends from the bundle 22, through the driver 50, tothe instrument 20, and the tool 18. The cabling extends about pulleys 29and into the slots 61 in the instrument driver 50. FIG. 7 illustratesthe driver 50 in a position in which it has entered the guide tube 24and transitions to a location essentially at the end of the guide tubewhere the tool 18 is located and at the operative site OS. At the end ofthe driver where the cable hooks engage, such as illustrated in FIGS. 5and 6, there is the coupling or interface section 59. FIG. 7 alsoillustrates the passages 46 and another non-selected tool within theinstrument storage chamber.

[0070] The construction of one form of tool is illustrated in FIGS. 8Aand 8B. This is in the form of a set of jaws or grippers. This tool isshown for the purpose of illustration, it being understood that avariety of other tool may be used. FIG. 8A is a perspective view showingthe tool pivoted at the wrist while FIG. 8B is an exploded view of thetool. The tool 18 is comprised of four members including the base 600,link 601, upper grip or jaw 602 and lower grip or jaw 603. The base 600is affixed to the flexible stem section 302. This flexible section maybe constructed of a ribbed plastic. This flexible section may be usedwhen a curved end guide tube (see FIG. 11) is used so that theinstrument will readily bend through the curved actuator tube 24.

[0071] The link 601 is rotatably connected to the base 600 about axis604. FIG. 8B illustrates a pivot pin at 620. The upper and lower jaws602 and 603 are rotatably connected to the link about axis 605, whereaxis 605 is essentially perpendicular to axis 604. FIG. 8B illustratesanother pivot pin at 624.

[0072] Six cables 606-611, shown schematically in FIG. 8A and FIG. 8B,actuate the four members 600-603 of the tool. Cable 606 travels throughthe insert stem (section 302) and through a hole in the base 600, wrapsaround curved surface 626 on link 601, and then attaches on link 601 at630. Tension on cable 606 rotates the link 601, and attached upper andlower grips 602 and 603, about axis 604( wrist pivot). Cable 607provides the opposing action to cable 606, and goes through the samerouting pathway, but on the opposite sides of the insert. Cable 607 mayalso attach to link 601 generally at 630. Cables 606 and 607 may be onecontinuous cable secured at 630.

[0073] Cables 608 and 610 also travel through the stem 302 and thoughholes in the base 600. The cables 608 and 610 then pass between twofixed posts 612. These posts constrain the cables to pass substantiallythrough the axis 604, which defines rotation of the link 601. Thisconstruction essentially allows free rotation of the link 601 withminimal length changes in cables 608-611. In other words, the cables608-611, which actuate the grips 602 and 623, are essentially decoupledfrom the motion of link 601. Cables 608 and 610 pass over roundedsections and terminate on grips 602 and 603, respectively. Tension oncables 608 and 610 rotate grips 602 and 603 counter-clockwise about axis605. Finally, as shown in FIG. 8B, the cables 609 and 611 pass throughthe same routing pathway as cables 608 and 610, but on the opposite sideof the instrument. These cables 609 and 611 provide the clockwise motionto grips or jaws 602 and 603, respectively. At the jaws 602 and 603, asdepicted in FIG. 8B, the ends of cables 608-611 may be secured at 635.This securing may occur with the use of an adhesive such as an epoxyglue or the cables could be crimped to the jaw.

[0074] Reference is now made to FIG. 9. FIG. 9 schematically illustratedan alternate embodiment of the present invention. In FIGS. 1-8 thedifferent instruments are selected by means of a rotating arrangement.In FIG. 9 the selection is made on an essentially linear basis. Thus,instead of the rotating member illustrated in FIGS. 1-8, there is a flatarray 70 also having a series of elongated passages 72 extendingtherethrough. Each of these passages accommodates an instrument. FIG. 9also schematically illustrates, by the same reference characters, theinstrument driver 50 and the outlet guide tube 24 such as previouslyillustrated in FIGS. 1-8. The flat array 70 may be driven selectively inthe direction of arrow 74 so as to align different ones of the passages72 with the driver 50 and guide tube 24. Mechanisms for selective lineardrive are well known, as are mechanisms for registration so as toprovide proper alignment between the instrument and instrument driver.

[0075] In connection with the aforementioned description of thecables/hooks, it is noted that the interchange system is designedpreferably to have all cabling maintained in tension. In this way, as aninstrument is engaged, all of the cabling running therethrough is intension and properly operative to control the end effector whether it bea set of jaws as illustrated in FIGS. 8A and 8B or some other type ofinstrument. If an end effector has less degrees of movement than thatillustrated in FIGS. 8A and 8B this is still effectively controlled, butwith the use of fewer cable control signals (fewer cables will actuallybe activated).

[0076] Reference is now made to the second robotic surgical systemdepicted in FIGS. 10-14, and that discloses a system having a greaternumber of degrees-of-freedom than the system described in FIGS. 1-8. InFIGS. 10-14 the same reference characters are used for similarcomponents as depicted in FIGS. 1-8.

[0077] The surgical robotic system, as illustrated in FIGS. 10-14,although preferably used to perform minimally invasive surgery, may alsobe used to perform other procedures as well, such as open or endoscopicsurgical procedures. FIG. 10 illustrates a surgical instrument system 10that includes a master station M at which a surgeon 2 manipulates aninput device, and a slave station S at which is disposed a surgicalinstrument. In FIG. 1 the input device is illustrated at 3 beingmanipulated by the hand or hands of the surgeon. The surgeon isillustrated as seated in a comfortable chair 4. The forearms of thesurgeon are typically resting upon armrests 5.

[0078]FIG. 10 illustrates a master assembly 7 associated with the masterstation M and a slave assembly 8 associated with the slave station S.Assembly 8 may also be referred to as a drive unit. Assemblies 7 and 8are interconnected by means of cabling 6 with a controller 9. Asillustrated in FIG. 10, controller 9 typically has associated therewithone or more displays and a keyboard. Reference is also made to, forexample, the aforementioned U.S. Ser. No. 10/014,143, for furtherdetailed descriptions of the robotic controller operation and associatedalgorithm.

[0079] As noted in FIG. 10, the drive unit 8 is remote from theoperative site and is preferably positioned a distance away from thesterile field. The drive unit 8 is controlled by a computer system, partof the controller 9. The master station M may also be referred to as auser interface vis-à-vis the controller 9. Commands issued at the userinterface are translated by the computer into an electronically drivenmotion in the drive unit 8. The surgical instrument, which is tetheredto the drive unit through the cabling connections, produces the desiredreplicated motion. FIG. 10, of course, also illustrates an operatingtable T upon which the patient P is placed.

[0080] Thus, the controller couples between the master station M and theslave station S and is operated in accordance with a computer algorithm.The controller receives a command from the input device 3 and controlsthe movement of the surgical instrument so as to replicate the inputmanipulation.

[0081] With further reference to FIG. 10, associated with the patient Pis the surgical instrument 14, which in the illustrated embodimentactually comprises two separate instruments one on either side of anendoscope E. The endoscope includes a camera to remotely view theoperative site. The camera may be mounted on the distal end of theinstrument insert, or may be positioned away from the site to provideadditional perspective on the surgical operation. In certain situations,it may be desirable to provide the endoscope through an opening otherthan the one used by the surgical instrument 14. In this regard, in FIG.10 three separate incisions are shown, two for accommodating thesurgical instruments and a centrally disposed incision that accommodatesthe viewing endoscope. A drape is also shown with a single opening.

[0082] The surgical instrument 14 is generally comprised of two basiccomponents including a surgical adaptor or guide 15 and an instrument14. FIG. 10 illustrates the surgical adaptor 15, which is comprisedprimarily of the guide tube 24. In FIG. 10 the instrument 14 is notclearly illustrated but extends through the guide tube 24. Theinstrument 14 carries at its distal end the tool 18. Descriptions of thesurgical instrument are found hereinafter in additional drawings,particularly FIG. 11. The surgical adaptor 15 is basically a passivemechanical device, driven by the attached cable array.

[0083] In FIG. 10 there is illustrated cabling 22 coupling from theinstrument 14 to the drive unit 18. The cabling 22 is preferablydetachable from the drive unit 8. Furthermore, the surgical adaptor 15may be of relatively simple construction. It may thus be designed forparticular surgical applications such as abdominal, cardiac, spinal,arthroscopic, sinus, neural, etc. As indicated previously, theinstrument 14 couples to the adaptor 15 and essentially provides a meansfor exchanging the instrument tools. The tools may include, for example,forceps, scissors, needle drivers, electrocautery etc.

[0084] Referring still to FIG. 10, the surgical system 10 may preferablybe used to perform minimally invasive procedures, although it is to beunderstood that the system may also be used to perform other procedures,such as open or endoscopic surgical procedures. The system 10 includes asurgeon's interface 11, computation system or controller 9, drive unit 8and the surgical instrument 14. The surgical system 10, as mentionedpreviously, is comprised of an adaptor or guide 15 and the instrument14. The system is used by positioning a tool 18 of the instrument, whichis inserted through the surgical adaptor or guide 15. During use, asurgeon may manipulate the input device 3 at the surgeon's interface 11,to effect desired motion of the tool 18 within the patient. The movementof the handle or hand assembly at input device 3 is interpreted by thecontroller 9 to control the movement of the guide tube 24, instrument,and tool 18.

[0085] The surgical instrument 14, along with the guide tube 24 ismounted on a rigid post 19 which is illustrated in FIG. 10 as removablyaffixed to the surgical table T. This mounting arrangement permits theinstrument to remain fixed relative to the patient even if the table isrepositioned. Although, in FIG. 10 there are illustrated two suchinstruments, even a single surgical instrument may be used.

[0086] As indicated previously, connecting between the surgicalinstrument 14 and the drive unit 8, are cablings. These include twomechanical cable-in-conduit bundles 21 and 22. These cable bundles 21and 22 may terminate at two connection modules, not illustrated in FIG.10 (see FIG. 1), which removably attach to the drive unit 8. Althoughtwo cable bundles are described here, it is to be understood that moreor fewer cable bundles may be used. Also, the drive unit 8 is preferablylocated outside the sterile field, although it may be draped with asterile barrier so that it may be operated within the sterile field.

[0087] In the preferred technique for setting up the system, and withreference to FIG. 10, the surgical instrument 14 is inserted into thepatient through an incision or opening. The instrument 14 is thenmounted to the rigid post 19 using a mounting bracket 31. The cablebundles 21 and 22 are then passed away from the operative area to thedrive unit 8. The connection modules of the cable bundles are thenengaged into the drive unit 8. The separate instrument members ofinstrument 14 are then selectively passed through the guide tube 24.This action is in accordance with the interchangeable instrumentconcepts of this invention.

[0088] The instrument 14 is controlled by the input device 3, which isbe manipulated by the surgeon. Movement of the hand assembly producesproportional movement of the instrument 14 through the coordinatingaction of the controller 9. It is typical for the movement of a singlehand control to control movement of a single instrument. However, FIG.10 shows a second input device that is used to control an additionalinstrument. Accordingly, in FIG. 10 two input devices are illustratedand two corresponding instruments. These input devices are usually forleft and right hand control by the surgeon.

[0089] The surgeon's interface 11 is in electrical communication withthe controller 9. This electrical control is primarily by way of thecabling 6 illustrated in FIG. 10 coupling from the bottom of the masterassembly 7. Cabling 6 also couples from the controller 9 to theactuation or drive unit 8. This cabling 6 is electrical cabling. Theactuation or drive unit 8, however, is in mechanical communication withthe instrument 14. The mechanical communication with the instrumentallows the electromechanical components to be removed from the operativeregion, and preferably from the sterile field. The surgical instrument14 provides a number of independent motions, or degrees-of-freedom, tothe tool 18. These degrees-of-freedom are provided by both the guidetube 24 and the instrument 14.

[0090]FIG. 10 shows primarily the overall surgical system. FIGS. 11-14show further details particularly of the interchangeable instrumentconcepts as applied to this system. FIG. 15 illustrates a controlalgorithm for the system. The system of FIG. 10 is adapted to provideseven degrees-of-freedom at the tool 18. Three of the degrees-of-freedomare provided by motions of the adaptor 15, while four degrees-of-freedommay be provided by motions of the instrument 14. As will be described indetail later, the adaptor is remotely controllable so that it pivots,translates linearly, and has its guide tube rotate. The instrument alsorotates (through the instrument driver), pivots at its wrist, and hastwo jaw motions at the tool.

[0091] Now, reference is made to the more detailed drawings of FIGS.11-14. FIG. 11 is a perspective view at the slave station of the systemof FIG. 10 illustrating the interchangeable instrument concepts. FIG. 12is a cross-sectional view through the storage chamber and as taken alongline 12-12 of FIG. 11. FIG. 13 is a longitudinal cross-sectional view,as taken along line 13-13 of FIG. 11. FIG. 14 is a perspective schematicview of the indexing and registration mechanism used in the embodimentillustrated in FIGS. 10-13.

[0092] Reference is now made to FIG. 11 which is a perspective viewillustrating the instrument 14 and the adaptor 15 at the slave stationS. This instrument system is secured in the manner illustrated in FIG.10 to the rigid post 19 that supports the surgical instrument by way ofthe mounting bracket 31 illustrated in FIG. 10, but not shown in FIG.11. FIG. 11 also shows several cables that may be separated into fivesets for controlling different motions and actions at the slave station.These are individual cables of the aforementioned bundles 21 and 22referred to in FIG. 10. FIG. 11 also illustrates the support yoke 220that is secured to the mounting bracket 31, the pivot piece 222, andsupport rails 224 for the carriage 226. The rails are supported in endpieces 241 and 262 with the end piece 241 attached to the pivot piece222. The pivot piece 222 pivots relative to the support yoke 220 aboutpivot pin 225. A base piece 234 is supported under the carriage 226 bymeans of the support post 228. The support post 228 in essence supportsthe entire instrument assembly, including the adaptor 15 and theinstrument 14.

[0093] As indicated previously, the support yoke 220 is supported in afixed position from the mounting bracket 31. The support yoke 220 may beconsidered as having an upper leg 236 and a lower leg 238. In theopening 239 between these legs 236 and 238 is arranged the pivot piece222. Cabling extends into the support yoke 220. This is illustrated inFIG. 11 by the cable set 501. Associated with the pivot piece 222 andthe carriage 226 are pulleys (not shown) that receive the cabling forcontrol of two degrees-of-freedom. This control from the cable set 501includes pivoting of the entire instrument assembly about the pivot pin225. This action pivots the guide tube 24 essentially in a single plane.This pivoting is preferably about an incision of the patient which isplaced directly under, and in line with, the pivot pin 225. Other cablesof set 501 control the carriage 226 in a linear path in the direction ofthe arrow 227. See also the cables 229 extending between the carriage226 and the end pieces 241 and 262. The carriage moves the instrumentand guide tube 24 back and forth in the direction of the operative siteOS. Incidentally, in FIG. 11 the instrument is in its fully advancedstate with the tool at the operative site OS.

[0094] The base piece 234 is the main support for the interchangeableinstrument apparatus of the invention. Refer to FIGS. 11-14. The basepiece 234 supports the guide tube 24, the instrument storage chamber540, and the instrument driver 550. The instrument driver 550 issupported from another carriage, depicted in FIGS. 11 and 13 as thecarriage 552, and that, in turn, is supported for translation on thecarriage rails 554. The rails 554 are supported at opposite ends at endpieces 556 and 558, in a manner similar to the support for the othercarriage 226. A support post 560 interconnects the carriage 552 with theinstrument driver housing 570.

[0095] With further reference to FIG. 11, and as mentioned previously,there are a number of cable sets from bundles 21 and 22 coupled to andfor controlling certain actions of the instrument system. Mention hasbeen made of the cable set 501 for controlling instrument pivoting andtranslation, as previously explained. In addition, FIG. 11 depicts fourother cable sets 503, 505, 507, and 509. Cable set 503 controls rotationof the guide tube 24. Cable set 505 controls the carriage 552, and, inturn, the extending and retracting of the instrument driver forinstrument exchange. Cable set 507 controls rotation of the instrumentthrough rotation of the instrument driver. Finally, cable set 509controls the tool via the instrument driver and instrument. There isalso one other set of control cables not specifically illustrated inFIG. 11 that controls the indexing motor 565, to be discussed in furtherdetail later.

[0096]FIG. 13 shows a cross-sectional view through the interchangeableinstrument portion of the overall instrument system. This clearlyillustrates the internal cable and pulley arrangement for the variousmotion controls. There is a pulley 301 driven from the cable set 503that controls rotation of the guide tube 24. There is also a pulley 303driven from cable set 505, along with a companion pulley 305 thatprovides control for the carriage 552. FIG. 13 also illustrates anotherpulley 307 driven from cable set 507, and for controlling the rotationof the instrument driver 550, and, in turn, the selected instrument.

[0097]FIG. 13 illustrates the guide tube 24 supported from the basepiece 234. The guide tube 24 is hollow and is adapted to receive theindividual instruments or work sections 541 disposed in the instrumentstorage chamber 540, as well as the instrument driver 550. Refer to FIG.7 for an illustration of the instrument and instrument driver positionedin the guide tube 24. FIG. 13 shows the instrument driver 550 in itsrest or disengaged position. The proximal end 24A of the guide tube 24is supported in the base piece 234 by means of a pair of bearings 235 sothat the guide tube 24 is free to rotate in the base piece 234. Thisrotation is controlled from the pulley 237 which is secured to the outersurface of the guide tube 24 by means of a set screw 231. The pulley 237is controlled to rotate by means of the cabling 310 that intercouplesthe pulleys 301 and 237 and that is an extension of the cabling 503.Thus, by means of the cable and pulley arrangement, and by means of therotational support of the guide tube 24, the rotational position of theguide tube 24 is controlled from cable set 503. Of course, thiscontrolled rotation is effected from the master station via thecontroller 9, as depicted in the system view of FIG. 10, and as afunction of the movements made by the surgeon at the user interface 11.

[0098] As indicated before the proximal end 24A of the guide tube 24 issupported from the base piece 234. The distal end of the guide tube 24,which is adapted to extend through the patient incision, and is disposedat the operative site OS illustrated about the tool 18 in FIG. 11, andwhere a medical or surgical procedure is to be performed. In the systemshown in FIG. 11 the distal end of the guide tube 24 is curved at 24B.In this way by rotating the guide tube 24 about its longitudinal axisthere is provided a further degree-of-freedom so as to place the endtool at any position in three-dimensional space. The rotation of theguide tube 24 enables an orbiting of the end tool about the axis of theguide tube 24. The guide tube 24 is preferably rigid and constructed ofa metal such as aluminum. The tool 18 illustrated in FIG. 11 may be thesame tool as illustrated in FIGS. 8A and 8B. Also, when the instrumentis fully engaged, as in FIG. 11, the cabling and cable interface is asillustrated in FIG. 7.

[0099]FIG. 13 also illustrates a cross-section of the instrument storagechamber 540 including the storage magazine 549, and showing two of thesix instrument passages 542 in the storage magazine 549. The instrumentstorage chamber may also be referred to herein as an instrumentretainer. In FIG. 13 one of the instruments 541 is about to be engagedby the instrument driver 550. The other instrument 541 is in place(storage or rest position) in the instrument storage chamber 540, andout of the path of the instrument driver 550. One of the instruments 541carries a gripper tool illustrated at 543, while the other instrumentcarries a scissors 544. Because these instruments are adapted to pass tothe guide tube 24 and be positioned at the distal end 24B thereof, thebody 548 of the instrument is flexible so as to be able to curve withthe curvature of the guide tube 24.

[0100] Although reference is made herein to the separate instrument andinstrument driver, such as illustrated in FIG. 13, once they are engagedthey function as a single piece instrument member. Accordingly referenceis also made herein to the instrument driver 550 as a “driver section”of the overall one piece instrument member, and the instrument 541 as a“working” section of the instrument member. The instrument member hasalso been previously discussed as having a “coupling section” or“interface section”, which is defined between the working section andthe driver section where the cables interlock by means of the engaginghook arrangement, such as clearly depicted in FIGS. 5 and 6. This isshown in FIG. 13 at 559. This is analogous to the interface 59illustrated in FIG. 7.

[0101] The carriage 552 illustrated in FIG. 13 is moved linearly by thecables 555 that extend between pulleys 303 and 305. These cables attachto the carriage 552. The carriage movement is controlled from cable set505. It is the movement of the carriage 552 that drives the instrumentdriver(driver section) 550. The instrument driver 550, in its rest ordisengaged position, is supported between the instrument driver housing570 and the wall 562 that is used for support of the instrument storagechamber 540. The instrument magazine 549 is rotationally supported bymeans of the axle or shaft 547, with the use of bushings or bearings,not shown. This support is between walls 562 and 563.

[0102]FIG. 13 shows the very distal end 525 of the instrument driver(transporter) 550 supported at wall 562. In the rest position of theinstrument driver 550 the driver is out of engagement with theinstruments and the magazine 549, thus permitting rotation of theinstrument storage chamber 540. The proximal end 526 of the instrumentdriver 550 is supported at the instrument driver housing 570. It may berotationally supported by means of a bushing 527. The instrument driver550 is supported for rotation, but rotation is only enabled once thedriver has engaged the instrument and preferably is at the operativesite. The rotation of the instrument driver 550 is controlled from cableset 503 by way of the pulley 307.

[0103] In FIG. 11 the cable set 509 is illustrated as controlling theinstrument motions including tool actuation. These cables control aseries of pulleys shown in FIG. 13 as pulleys 529. As indicted in FIG.13 these pulleys control cabling that extends through the instrumentdriver and the instrument for control of instrument and tool motions.The cables that are controlled from these pulleys may control threedegrees-of-freedom of the instrument, including pivoting at the wristand two for gripper action. For the details of the interlocking of theinstrument and instrument driver refer to FIGS. 5 and 6. The sameengagement arrangement can be used in this second embodiment of theinvention including the mating hook arrangement, interlocked atinterface 559 when the instrument driver and instrument are engaged.

[0104] Reference has been made before to the indexing motor 565. Thismotor is illustrated in FIG. 11 positioned next to the base piece 234,and is further illustrated in FIG. 14 located for interaction with theinstrument storage chamber 540. The indexing motor 565 is controlledfrom the master station side, and accordingly there is another cable set(not shown) that actuates the indexing motor 565. The indexing motor 565may be a stepper motor having a degree of rotation that corresponds tothe desired rotation of the instrument storage chamber 540. The steppermotor may be designed to provide 60 degrees of rotation for eachactuation, corresponding to an instrument storage chamber 540 having sixpassages (360 degrees divided by 6) for receiving instruments.

[0105] In FIG. 14 the stepper motor 565 has an output shaft 566 thatsupports an indexing disk 567, shown also in dashed line in FIG. 12. Theindexing disk 567 is fixed to the shaft 566 and so rotates with theshaft 566. FIG. 12 illustrates the disk 567 carrying four pins 568disposed at the periphery of the disk 567. FIG. 14 also shows these pins568. The pins 568 selectively engage in indexing slots 569 in an endwall of the magazine 549. To insure that the rotating chamber stays inproper registration with the instrument driver a spring and ball detentarrangement is employed. Refer to FIGS. 11-14 illustrating a standardball and spring member 575 supported in the wall 563. The ball of member575 is urged against an end wall surface 576 of the magazine 549. Thisend wall has a series of detent dimples 577 (see FIG. 14) disposed atlocations corresponding to the passages in the magazine 549. The steppermotor 565 is selectively operated under surgeon control from the masterstation. Each step rotates the disk 567 through 90 degrees. Theengagement of the pins 568 with the slots 569 causes a correspondingrotation of the magazine 549 through 60 degrees. Each subsequentrotation of the stepper motor 565 causes a further 60 degree rotation ofthe magazine 549. The stepper motor 565 is controllable in a manner sothat, with proper decoding, there may be multiple step actuations to getfrom one instrument to the next selected instrument.

[0106] The operation of the slave instrument is in a robotic manner fromthe master station, such as illustrated in FIG. 10. The surgeon cancontrol several degrees-of-freedom of the instrument system. Inaddition, when the surgeon wishes to exchange instruments this can bedone directly from the master station from an actuation member and atthe proper time in the surgical procedure. One type of actuation membermay be by means of a foot switch 410 illustrated in FIG. 10 withinaccess of the surgeon. The foot switch 410 couples to the controller 9.Appropriate electrical signals are coupled from the master station tothe slave station basically to control the stepper motor 565 forindexing the magazine 549.

[0107] The sequence of operation for the indexing is demonstrated in theflow chart of FIG. 15. This block diagram indicates the sequence ofsteps performed commencing with a rest position of the system in whichthe instruments are all in place in the storage chamber 540, and theinstrument driver is in the position substantially as illustrated inFIG. 13, just out of contact with the registered instrument and with thedriver end 525 disposed in the wall 562. It is this position that isillustrated in FIG. 15 by box 420. The next step is to check theregistration of the instrument driver with the instrument itself. Thisis depicted by the box 422. This step may involve the use of some knownregistration system, such as one using an optical sensing arrangement todetermine proper registration between the instrument driver 550 and eachof the passages in the magazine 549, along with the instrument 541. Ifproper registration is detected then the system proceeds to the nextstep indicated in FIG. 15 by box 426, which activates the instrumentdriver 550. This starts the process of driving the instrument to theoperative site OS. This involves mechanical control signals on the cableset 505 controlling the carriage 552, and in turn, the instrument driver550. If an improper registration is detected then box 424 indicates thestep of correcting the registration. This may be carried out in a wellknown manner with the use of an optical system to provide slightrotation to the instrument storage chamber 540 so as to obtain properregistration. This system may also use some type of a feedback system.

[0108] The next step in the system is indicated in FIG. 15 by the box428 which simply detects the fully engaged position of the instrumentdriver and instrument. This is the position illustrated in FIG. 11.Again, this position can be readily detected by optical means. The nextstep illustrated in FIG. 15 by box 430 is one that commences theinterchange process. The intercoupled instrument and instrument driverare withdrawn. This involved movement of the carriage 552 in theopposite direction. Next, indicated by box 432, is where the instrumentand instrument driver have reached the position illustrated in FIG. 13previously referred to as the “rest position”. In that position theinstrument driver (transporter) 550 is clear of the instrument storagechamber 540, and thus the instrument storage chamber 540 can be indexed(rotated). This is shown in FIG. 15 by the box 434. Following thesesteps, from FIG. 15 it is seen that there may be another registrationcheck (box 436), and a correction (box 438), in a manner similar to theoperation previously discussed regarding boxes 422 and 424. The processcan then repeat at a time determined by the surgeon's instrumentselection sequence.

[0109] There has to be some correlation between the indexing, what andwhere particular instruments are stored, and how the indexing iscontrolled from the master station. As indicated previously a footswitch can be used, such as the switch 410 illustrated in FIG. 10. Inone version of the control the switch 410 may be comprised of sixseparate actuation buttons, each one corresponding to one of the sixinstruments disposed in the instrument storage chamber 540. Indicia maybe provided associated with the storage chamber to indicate whatparticular instrument is disposed in what particular instrument passage.In this way the surgeon would know what button to actuate to select thedesired instrument. There could be corresponding indicia associated withthe switch buttons so the surgeon knows what button corresponds exactlyto what instrument.

[0110] The control system for indexing may also include a decodingscheme so that when the surgeon makes a selection the decoder determinesthe number of rotations (such as of the stepper motor 565) necessary tobring the instrument driver into proper registration with the selectedinstrument. Because it may not always be clear as to the specificinstrument sequence that the surgeon will use, the system has todetermine how to index from one instrument to the next one selected.This selection process involves more than just sequencing from oneinstrument to an adjacent instrument. The process will have toaccommodate a selection process in which the next selected instrument isnot the adjacent instrument. Thus a simple decoder can be used todetermine the number of stepper motor steps necessary to move thestorage chamber to the next selected instrument.

[0111] Another aid that can be provided to the surgeon is a visibledisplay illustrated in FIG. 10, and on which there can be a diagram thatmatches the storage chamber pattern showing to the surgeon exactly whereeach instrument is placed including the type of instrument. This couldbe set up when the instruments are first selected the disposed in theinstrument storage chamber 540. In association with this display onecould also provide, in place of the switch 410, a voice activated systemso that the surgeon simply indices by voice which instrument to select.This may be done by simply numbering the instruments, such as onethrough six. A further variation may use a touch screen so that thesurgeon simply touches an area on the screen corresponding to thedisplayed image of the storage chamber with the stored instruments. Inall of the above instances, there are electrical signals generated fromthe master station, through a touch screen, switch, etc. that areconveyed to the controller 9 and from there to the slave side. Theactivating signals at the slave side basically control the stepper motor565 via a cable set not specifically shown in the drawings but thatwould couple to the stepper motor 565 illustrated in FIGS. 11, 12 and14.

[0112] Reference is now made to FIG. 16 for a schematic representationof a further alternate embodiment of the invention. In FIGS. 1 and 10 itis noted that the instruments are contained in a parallel array. Inaccordance with the invention the instruments may also be disposed in aseries array, as depicted in the schematic diagram of FIG. 16. Thisembodiment includes a retainer 580 that is adapted to store a series ofinstruments 581 in a serial array, also referred to herein as a linearchamber or linear retainer. Means are provided to enable the array tomove laterally in the directions indicated by arrows 585. This movementcan be of either the retainer or the instruments themselves. There is analignment that occurs so that a selected instrument may align with aport 584 from which the instrument may then be moved to location 583.This is by a lateral or transverse movement of the instrument out of theretainer 580. This movement is indicated in FIG. 16 by the arrow 587.The instrument, once moved, is then in registration with the driver ortransporter 580 which is moveable in the direction of arrow 588. Thedriver is controlled as in previous embodiments to transition theinstrument to the operative site, through the represented output port586.

[0113] Although reference is made herein to “surgical instrument” it iscontemplated that the principles of this invention also apply to othermedical instruments, not necessarily for surgery, and including, but notlimited to, such other implements as catheters, as well as diagnosticand therapeutic instruments and implements.

[0114] Having now described certain embodiments of the presentinvention, it should be apparent to one skilled in the art that numerousother embodiments and modifications thereof can be made, some of whichhave already been described, and all of which are intended to fallwithin the scope of the present invention. For example, the couplingsections or interface sections have been disclosed as intercoupledcables with hook arrangements, such as shown in FIG. 6. In anotherarrangement a different mechanical coupling scheme may be employed usinga different interlock between cables. Also, in place of mechanicalcouplings other technologies may be used for coupling action to theinstrument and tool, such as SMA technology. Regarding the tool itself,one has been illustrated with a wrist pivot. Instead the tool mayinclude a bendable section at or near its distal end. In place of thestepper motor other indexing arrangements can be used, such as a ratchetand pawl system. Also, encoders can be used at the rotating storagechamber to detect motions to provide feedback for controlling theoverall system.

What is claimed is:
 1. An interchangeable instrument apparatus,comprising: a plurality of separate instrument members each capable ofassisting in a different phase of a medical procedure to be performed atan operative site within the anatomy; an instrument storage chamber forreleasably receiving said plurality of instrument members, accommodatedin separate storage locations within the instrument storage chamber; aninstrument driver constructed and arranged for cooperative positioningrelative to the instrument storage chamber, for selective alignment withone of said instrument members at a time, and for displacing the alignedinstrument member from the instrument storage chamber toward theoperative site; at least one of said instrument driver and instrumentstorage chamber being positionally controllable so as to providerelative displacement therebetween to selectively align said instrumentdriver with another of said instrument members.
 2. A system as set forthin claim 1 wherein said instrument storage chamber comprises a rotatingchamber having a plurality of passages therein.
 3. A system as set forthin claim 2 wherein said instrument member has a rest storage positionwhen disposed in the instrument storage chamber, and a working positionwhen coupled to the operative site, and further including an outletguide tube having a distal end of the instrument extending from a distalend of the guide tube when the instrument is in its working position. 4.A system as set forth in claim 3 including an indexing device forcausing relative displacement between the instrument members and theoutlet guide tube for rotating said instrument storage chamber so thatdifferent ones of said instrument members may be aligned with saidoutlet guide tube.
 5. A system as set forth in claim 4 wherein saidinstrument driver is supported by a carriage for linear translation ofthe instrument driver.
 6. A system as set forth in claim 1 wherein saidinstrument driver has cabling and said instrument member has cabling. 7.A system as set forth in claim 6 further including a coupling interfacefor selectively connecting the cabling of the instrument driver with thecabling of the instrument member.
 8. A system as set forth in claim 7wherein said coupling interface comprises corresponding hooks associatedwith said instrument driver and said instrument member, and engagablewhen the driver selects a particular instrument member.
 9. A system asset forth in claim 8 further including a base piece for supporting saidcarriage for rotation about a central axis.
 10. A system as set forth inclaim 9 wherein each passage in the instrument storage chamber has anenlarged section to facilitate disengagement of said engagable hook. 11.A system as set forth in claim 10 wherein facing ends of said instrumentdriver and instrument member have interlocking surfaces.
 12. A system asset forth in claim 1 wherein said instrument carries a tool at itsdistal end, said tool being controlled from a drive unit.
 13. A systemas set forth in claim 12 wherein said tool is remotely operated from auser interface by way of an electrical controller.
 14. A system as setforth in claim 13 including an indexing mechanism for controlling theposition of said instrument storage chamber.
 15. A system as set forthin claim 14 including an actuation member at said user interface forremotely controlling said indexing mechanism.
 16. A system as set forthin claim 15 wherein the actuation member includes at least one of aswitch, touch screen, pointer, or voice activation device.
 17. A methodof delivering to an internal operative site a selected one of aplurality of instruments, said method comprising the steps of: storing aplurality of separate instruments in a storage chamber with eachinstrument capable of assisting in a different phase of a medicalprocedure to be performed at the operative site; providing an instrumentdriver constructed and arranged for; cooperative positioning relative tothe instrument storage chamber, selective alignment with one of saidinstruments at a time, and displacing the aligned instrument from theinstrument storage chamber; and positionally controlling at least one ofsaid instrument driver and instrument storage chamber so as to providerelative displacement therebetween and so as to selectively align saidinstrument driver with another of said instrument members.
 18. A methodas set forth in claim 17 including guiding the instrument when it isdisplaced by means of a guide tube.
 19. A method as set forth in claim17 wherein the step of positionally controlling to provide relativedisplacement includes causing relative rotation.
 20. A method as setforth in claim 17 wherein the step of positionally controlling toprovide relative displacement includes causing linear movement.
 21. Asurgical instrument apparatus, comprising: an instrument memberincluding; a work section that supports at its distal end a tool used inperforming a medical procedure at an operative site within the anatomy,a driver section that is releasably engageable with the work section,and a guide member for receiving said work section and said drivesection, and for directing, upon engagement of said driver section withsaid work section, the delivery of the tool to the operative site; thedriver section, in an inoperative position thereof, disengaged from thework section, and in an operative position thereof, engageable with thework section to direct the work section, via the guide member, to theoperative site, and further engageable with the work section to enableoperative coupling to the tool for actuation of the tool from a remotedrive unit.
 22. An apparatus as set forth in claim 21 further includingan interface section for selectively and releasably intercoupling thedriver and work sections.
 23. An apparatus as set forth in claim 22further including interconnecting hooks, one set associated with saiddriver section and one set associated with said work section andinterengageable when the work section and the driver section areinterengaged so as to provide cable continuity from the driver section,through the work section to the tool.
 24. An apparatus as set forth inclaim 23 further including a carriage for supporting said driver sectionand for moving said driver section toward and away from a storagechamber for the work section.
 25. An apparatus as set forth in claim 24wherein said storage chamber has passages for receiving a plurality ofwork sections, and each passage in said storage chamber has an enlargedportion to facilitate release between said driver section and said worksection.
 26. An apparatus as set forth in claim 25 including an indexingdrive for selectively rotating the instrument storage chamber.
 27. Anapparatus as set forth in claim 21 including a storage chamber forholding a plurality of work sections, and an indexing device forproviding relative displacement between the storage chamber and thedriver section so that different ones of the work sections may bealigned with the driver sections.
 28. An apparatus as set forth in claim27 wherein said indexing device rotates the storage chamber.
 29. Anapparatus as set forth in claim 27 wherein said indexing device causeslinear translation of said storage chamber.
 30. An apparatus as setforth in claim 21 wherein facing ends of the driver section and the worksection have interlocking surfaces that enable the driver section toproperly position the work section while effecting inter-couplingbetween the inter-coupling cables.
 31. An apparatus as set forth inclaim 27 wherein said tool is remotely operated. from a user interfaceby way of an electrical controller.
 32. An apparatus as set forth inclaim 31 including an actuation member at said user interface forremotely controlling said indexing mechanism.
 33. A system as set forthin claim 32 wherein the actuation member includes at least one of aswitch, touch screen, pointer, or voice activation device.
 34. Aninterchangeable instrument system, comprising: a storage retainer thatsupports a plurality of separately arranged instruments, and furtherincludes inlet and outlet ports, the outlet port arranged in alignmentwith the target or operative site where the instrument is to bedelivered for performing a medical procedure; a work implement supportedat the distal end of each instrument; an instrument transporter inalignment with the inlet port, and adapted to engage a registeredinstrument disposed in the storage retainer, so as to deliver theselected instrument, via the outlet port to the target or operativesite; said instrument transporter, in addition to engagement with theinstrument, also operatively coupling with and enabling operation of thework implement of the instrument; said storage retainer beingselectively operable, upon command, to permit different instruments toalign between the inlet and outlet ports.
 35. A system as set forth inclaim 34 wherein said work implement is remotely operated from a userinterface by way of an electrical controller.
 36. A system as set forthin claim 35 wherein said retainer comprises an instrument storagechamber and further including an indexing mechanism for controlling theposition of said instrument storage chamber.
 37. A system as set forthin claim 36 including an actuation member at said user interface forremotely controlling said indexing mechanism.
 38. A system as set forthin claim 37 wherein the actuation member includes at least one of aswitch, touch screen, pointer, or voice activation device.
 39. Aninterchangeable instrument system, comprising: an instrument retainerhaving multiple storage location for receiving a plurality ofinstruments disposed separately in the respective storage locations; aninstrument driver constructed and arranged for cooperative positioningrelative to the instrument retainer, for selective alignment with one ofsaid instruments at a time, and for displacing the aligned instrumentfrom the instrument retainer toward the operative site; an indexingmechanism controlling the position of the instrument retainer so as toselectively align different instruments with the instrument driver; andan actuation member disposed at a user interface for controlling saidindexing mechanism.
 40. A system as set forth in claim 39 wherein saidindexing mechanism is remotely operated from a user interface by way ofan electrical controller.
 41. A system as set forth in claim 39 whereinthe actuation member includes at least one of a switch, touch screen,pointer, or voice activation device.
 42. A system as set forth in claim39 wherein said user interface is a remote user interface.
 43. Aninterchangeable instrument system, comprising: a plurality of medicalinstruments; an instrument retainer for releasably holding saidplurality of instruments; an instrument transporter associated with theinstrument retainer, for selective alignment with one of saidinstruments at a time, and for displacing the aligned instrument fromthe instrument retainer toward an operative site in a subject.
 44. Aninterchangeable instrument system as set forth in claim 43 including atleast one of said instrument retainer and instrument transporter beingpositionally controllable so as to provide relative displacementtherebetween to selectively align said instrument transporter withanother of said instruments.
 45. An interchangeable instrument system asset forth in claim 43 wherein said instrument retainer comprises arotating chamber having a plurality of passages therein.
 46. Aninterchangeable instrument system as set forth in claim 43 wherein saidinstrument retainer comprises a linear chamber for receiving theinstruments.
 47. An interchangeable instrument system as set forth inclaim 46 wherein said transporter is positioned in parallel to saidlinear chamber, and a selected instrument is moved transversely out ofsaid chamber for alignment with said instrument transporter.
 48. Aninterchangeable instrument system as set forth in claim 43 whereinincluding an indexing mechanism controlling the position of theinstrument retainer so as to selectively align different instrumentswith the instrument transporter.
 49. An interchangeable instrumentsystem as set forth in claim 48 including an actuation member disposedat a remote user interface for controlling said indexing mechanism. 50.A remotely controllable medical apparatus comprising: a remote userinterface manually manipulable by a user for sending operation commandsignals to a signal processor, the signal processor processing thecommand signals and sending processed signals to a drive mechanism; aninstrument exchange mechanism mechanically intercoupled to the drivemechanism; the instrument exchange mechanism comprising a shaft and aninstrument delivery mechanism containing two or more selected; the shafthaving a lumen which readily receives the selected instruments forinsertion and withdrawal from the lumen; the instrument deliverymechanism being drivably movable to align a selected instrument with thelumen of the shaft for insertion and withdrawal to and from the lumen,the instrument delivery mechanism being remotely drivable via the userinterface to insert and withdraw selected instruments.
 51. A remotelycontrollable medical apparatus comprising: a remote user interfacemanually manipulable by a user for sending operation command signals toa signal processor, the signal processor processing the command signalsand sending processed signals to a drive mechanism; an instrumentexchange mechanism mechanically intercoupled to the drive mechanism; theinstrument exchange mechanism comprising a shaft and an instrumentdelivery mechanism containing two or more selected instruments; theshaft having a lumen which readily receives the selected instruments forinsertion and withdrawal from the instrument delivery mechanism; aninstrument drive mechanism mechanically intercoupled to the drivemechanism and readily mechanically couplable to and decouplable from aninstrument; the instrument drive mechanism being remotely drivable viathe user interface to operably couple to and drive an instrument.